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Ultrasound in evaluation of post-interventional femoral vein obstruction: a case report.

L√łnnebakken MT, Gerdts E, Wirsching J, Pedersen OM - Cardiovasc Ultrasound (2009)

Bottom Line: Ultrasound is the preferred imaging modality in diagnosis of vascular complications following cardiac catheterization and intervention.CT showed that the common femoral vein was compressed at the puncture site by surrounding haemorrhages.Thus, when bleeding due to cardiac catheterization is associated with possible venous obstruction and findings by color Doppler are equivocal due to degradation of the color-Doppler image, detection of venous hypertension by spectral Doppler, performed distal to the bleeding area, strongly supports the presence of venous obstruction where the exact cause may be established by CT.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. mai.tone.lonnebakken@helse-bergen.no

ABSTRACT
Ultrasound is the preferred imaging modality in diagnosis of vascular complications following cardiac catheterization and intervention. In some cases, however, bleeding surrounding the femoral vessels, may severely distort the color Doppler images, making detection of venous complications especially difficult. This report refers to such a case where post-catheterization haematoma was suspected to cause an obstruction of the femoral vein. Spectral Doppler recordings of blood flow in the common femoral vein, up-stream, distal to the hemorrhagic area, confirmed the diagnosis of obstruction by demonstrating changes in the venous flow pattern in the common femoral vein, consistent with venous hypertension. Due to the poor quality of the ultrasound images, the exact cause of the obstruction had to be established by another imaging modality, not affected by haemorrhages. CT showed that the common femoral vein was compressed at the puncture site by surrounding haemorrhages. Thus, when bleeding due to cardiac catheterization is associated with possible venous obstruction and findings by color Doppler are equivocal due to degradation of the color-Doppler image, detection of venous hypertension by spectral Doppler, performed distal to the bleeding area, strongly supports the presence of venous obstruction where the exact cause may be established by CT.

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Short axis Power Doppler image showing the right common femoral artery (RCFA) and the non-compressible right femoral vein (RCFV), surrounded by hypoechogenic tissue consisting of perivascular hematoma, at first suspected to represent deep vein thrombosis (DVT).
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Figure 1: Short axis Power Doppler image showing the right common femoral artery (RCFA) and the non-compressible right femoral vein (RCFV), surrounded by hypoechogenic tissue consisting of perivascular hematoma, at first suspected to represent deep vein thrombosis (DVT).

Mentions: US examination of the proximal right CFV, the following day, showed signs of bleeding at the arterial puncture site, which caused considerable degradation of the color-Doppler image due to scattering of the ultrasound. Despite these problems color Doppler demonstrated a 5 cm long cylindric hypo-echogenic structure with a centrally located channel of venous blood flow medial to the CFV (Fig. 1). A possible venous obstruction, due to a partially occluding intraluminal thrombus or to extrinsic compression of the vein lumen by surrounding haematoma, could not be ruled out. Spectral Doppler recordings, obtained away from the puncture site at the distal part of the right CFV, demonstrated unilateral loss of the normal phasic variations in flow velocities, consistent with venous hypertension (Fig. 2, 3). Subsequent assessment of the proximal CFV by CT, being unaffected by haemorrhages, demonstrated partial compression of a 5 cm long vein segment of the CFV at the level of the arterial puncture site, caused by surrounding haematoma (Fig. 4).


Ultrasound in evaluation of post-interventional femoral vein obstruction: a case report.

L√łnnebakken MT, Gerdts E, Wirsching J, Pedersen OM - Cardiovasc Ultrasound (2009)

Short axis Power Doppler image showing the right common femoral artery (RCFA) and the non-compressible right femoral vein (RCFV), surrounded by hypoechogenic tissue consisting of perivascular hematoma, at first suspected to represent deep vein thrombosis (DVT).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2667400&req=5

Figure 1: Short axis Power Doppler image showing the right common femoral artery (RCFA) and the non-compressible right femoral vein (RCFV), surrounded by hypoechogenic tissue consisting of perivascular hematoma, at first suspected to represent deep vein thrombosis (DVT).
Mentions: US examination of the proximal right CFV, the following day, showed signs of bleeding at the arterial puncture site, which caused considerable degradation of the color-Doppler image due to scattering of the ultrasound. Despite these problems color Doppler demonstrated a 5 cm long cylindric hypo-echogenic structure with a centrally located channel of venous blood flow medial to the CFV (Fig. 1). A possible venous obstruction, due to a partially occluding intraluminal thrombus or to extrinsic compression of the vein lumen by surrounding haematoma, could not be ruled out. Spectral Doppler recordings, obtained away from the puncture site at the distal part of the right CFV, demonstrated unilateral loss of the normal phasic variations in flow velocities, consistent with venous hypertension (Fig. 2, 3). Subsequent assessment of the proximal CFV by CT, being unaffected by haemorrhages, demonstrated partial compression of a 5 cm long vein segment of the CFV at the level of the arterial puncture site, caused by surrounding haematoma (Fig. 4).

Bottom Line: Ultrasound is the preferred imaging modality in diagnosis of vascular complications following cardiac catheterization and intervention.CT showed that the common femoral vein was compressed at the puncture site by surrounding haemorrhages.Thus, when bleeding due to cardiac catheterization is associated with possible venous obstruction and findings by color Doppler are equivocal due to degradation of the color-Doppler image, detection of venous hypertension by spectral Doppler, performed distal to the bleeding area, strongly supports the presence of venous obstruction where the exact cause may be established by CT.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. mai.tone.lonnebakken@helse-bergen.no

ABSTRACT
Ultrasound is the preferred imaging modality in diagnosis of vascular complications following cardiac catheterization and intervention. In some cases, however, bleeding surrounding the femoral vessels, may severely distort the color Doppler images, making detection of venous complications especially difficult. This report refers to such a case where post-catheterization haematoma was suspected to cause an obstruction of the femoral vein. Spectral Doppler recordings of blood flow in the common femoral vein, up-stream, distal to the hemorrhagic area, confirmed the diagnosis of obstruction by demonstrating changes in the venous flow pattern in the common femoral vein, consistent with venous hypertension. Due to the poor quality of the ultrasound images, the exact cause of the obstruction had to be established by another imaging modality, not affected by haemorrhages. CT showed that the common femoral vein was compressed at the puncture site by surrounding haemorrhages. Thus, when bleeding due to cardiac catheterization is associated with possible venous obstruction and findings by color Doppler are equivocal due to degradation of the color-Doppler image, detection of venous hypertension by spectral Doppler, performed distal to the bleeding area, strongly supports the presence of venous obstruction where the exact cause may be established by CT.

Show MeSH
Related in: MedlinePlus